P9 · Risk of self-harm (needs urgent response)
Risk ⚠ URGENT Emotions and mind
Definition
Thoughts or signs of wanting to end life or cause harm. Needs immediate safety steps and urgent specialist support.- Depression
- previous attempt
- loss
- illness
- substance use
- access to means
- Talk of death
- hopelessness
- giving away items
- sudden calm
- withdrawal
📋 Scenario
A patient with depression, who lost his job two weeks ago, says everyone would be better off without him.
Subjective (S): "Everyone would be better off without me."
Objective (O): Hopeless statements; withdrawn; history of depression; previous attempt two years ago; job loss two weeks ago; eating little.
Assessment tools for this scenario: CP-MIND Mood & Mind Screen
Validated scales to consider: PHQ-9, GAD-7, C-SSRS
**CarePath diagnosis:** Risk of self-harm related to depression, a previous attempt and recent job loss (risk factors), with hopeless statements and withdrawal (warning signs); needs urgent response.
**Interventions and rationale**
| Intervention | Rationale |
|---|---|
| Take every statement seriously and stay with the patient. | Every statement about wanting to die may signal real danger, and staying with the patient keeps him safe, shows he is valued and reduces the isolation that raises risk. |
| Ask directly and kindly about thoughts of suicide and use the structured risk tool required by local policy. | Asking directly does not cause suicidal thoughts and gives permission to talk. A structured tool gives a consistent, policy-based measure of risk to guide the level of observation. |
| Remove hazards and keep the patient under the observation level ordered. | Removing hazards limits access to means at a time of crisis, and the ordered observation level makes sure he is watched closely enough to stay safe. |
| Alert the team and the doctor immediately and follow the safety policy. | Immediate alerting makes sure a doctor and team can assess risk and act quickly, and following policy makes sure the right protections are in place. |
| Arrange urgent specialist mental health review. | A mental health specialist can assess depression and risk in depth and decide on treatment and the level of care he needs. |
| Agree a written safety plan before discharge or transfer. | A written plan, made with him, sets out warning signs, coping steps and contacts, so he has a clear guide for moments of crisis after leaving. |
**Expected outcomes**
- Patient remains safe with no self-harm during the stay.
- Urgent mental health review completed.
- Patient helps write a safety plan and names two people or services to call.
**Linking the data to the diagnosis**
This is an urgent risk diagnosis, so the nurse calls for help and stays with the patient first. He has said, "Everyone would be better off without me," and is withdrawn, eating little and hopeless. Risk factors are depression, a previous attempt two years ago and job loss two weeks ago. Self-harm has not occurred, so the diagnosis rests on risk factors and warning signs, not on harm. The plan aims for safety during the stay, an urgent mental health review and a safety plan he helps write, naming two people or services to call.
CarePath diagnosis
Risk of self-harm related to depression, a previous attempt and recent job loss (risk factors), with hopeless statements and withdrawal (warning signs); needs urgent response.
Interventions and rationale
Listed in priority order — for urgent statements the first action is to get help.
| Intervention | Rationale |
|---|---|
| 1. Take every statement seriously and stay with the patient. | Every statement about wanting to die may signal real danger, and staying with the patient keeps him safe, shows he is valued and reduces the isolation that raises risk. |
| 2. Ask directly and kindly about thoughts of suicide and use the structured risk tool required by local policy. | Asking directly does not cause suicidal thoughts and gives permission to talk. A structured tool gives a consistent, policy-based measure of risk to guide the level of observation. |
| 3. Remove hazards and keep the patient under the observation level ordered. | Removing hazards limits access to means at a time of crisis, and the ordered observation level makes sure he is watched closely enough to stay safe. |
| 4. Alert the team and the doctor immediately and follow the safety policy. | Immediate alerting makes sure a doctor and team can assess risk and act quickly, and following policy makes sure the right protections are in place. |
| 5. Arrange urgent specialist mental health review. | A mental health specialist can assess depression and risk in depth and decide on treatment and the level of care he needs. |
| 6. Agree a written safety plan before discharge or transfer. | A written plan, made with him, sets out warning signs, coping steps and contacts, so he has a clear guide for moments of crisis after leaving. |
Expected outcomes
- Patient remains safe with no self-harm during the stay.
- Urgent mental health review completed.
- Patient helps write a safety plan and names two people or services to call.
Linking the data to the diagnosis
This is an urgent risk diagnosis, so the nurse calls for help and stays with the patient first. He has said, "Everyone would be better off without me," and is withdrawn, eating little and hopeless. Risk factors are depression, a previous attempt two years ago and job loss two weeks ago. Self-harm has not occurred, so the diagnosis rests on risk factors and warning signs, not on harm. The plan aims for safety during the stay, an urgent mental health review and a safety plan he helps write, naming two people or services to call.